A residential facility that provides care for people whose physical and health circumstances prevent them from living independently. State agencies accredit or license long-term facilities according to state laws and regulations (including mEdicaid) as well as in compliance with federal medicare regulations. The staff at long-term care facilities include registered nurses, licensed practical nurses (called licensed vocational nurses in some states), certified nursing assistants, physical therapists, occupational therapists, speech pathologists, recreational therapists, dietitians, and other allied health care personnel. Long-term care facilities provide complete care, including personal care and any needed medical treatments. There are no limits to the time a person can remain in a long-term care facility.
The decision to move a person with Parkinson’s to a long-term care facility is a difficult and emotional one for families. It requires a candid assessment of the person’s abilities, needs, and rate of decline. planning for the future when the person with Parkinson’s can express his or her preferences and participate in care decisions makes the process easier. Planning also allows time to make a careful selection of the facilities that the person and family members consider best suited to the person’s needs. Most long-term care facilities have admissions coordinators on staff who can talk with families about care needs, services the facility provides, and financial matters.
Facility Licensing or Certification
All states have licensing requirements for residential care facilities, typically managed through the state’s department of health and social services, these requirements vary considerably among states. Choose a facility that meets Medicare and Medicaid standards, regardless of the financial status of the person with Parkinson’s, to assure the most consistent level of care. Ask to see documentation of licensing or certification. Also ask the facility as well as the state’s licensing agency to review all records for inspections and any disciplinary or censure actions. Additionally, look for a long-term care facility that is certified by an industry organization to meet industry-established standards of care. Finally, check with the local Better Business Bureau and similar organizations to see whether there are complaints about the way the facility does business.
Visit the long-term care facility several times. It is good to schedule an appointment with the facility’s admissions coordinator or director and to have an escorted tour of the facility to see all areas of interest. It is also important to drop by the facility at varying times during the day, to get a sense of the level of activity, efforts and attitude of the staff, and overall operational mode of the facility. These drop-in visits should include a brief look at common areas such as dining rooms as well as walking down corridors where resident rooms are located. Some facilities ask all visitors to check in at the office; if this is the case, someone should be available to walk along on the “tour” if the facility requires this. Be leery of any facility that allows visits only with scheduled appointments.
On visits to facilities, pay attention to
• Cleanliness: Floors, walls, and furniture should look and feel clean. Corridors should be free of clutter such as wheelchairs, walkers, laundry carts, utility carts, and other objects that block clear passage. The facility should smell clean as well.
• Staff attitude and appearance: Do staff smile and greet residents and visitors? How do staff address residents? Are staff neatly dressed and groomed?
• Staff attentiveness: Do all staff appear engaged with resident care? How long do they take to answer call lights?
• Resident appearance: Are residents up in chairs or walking during the main part of the day? or do most residents appear to be lying in bed? Do residents appear clean, appropriately clothed, and comfortable? This is a key reason to visit at different times of the day, to get a sense of the facility’s routines and how residents spend their time.
• Activities: What level of organized or structured activities take place during the day? Do staff seem enthusiastic? Do residents actively participate? Are there a variety of activities to meet different interests and needs?
• Meals: Ask to walk through the dining room. Do meals look inviting? Do people appear to be enjoying their food? Are there enough staff to assist residents who need help?
• Medical care: Is it possible to identify staff who are nurses? Are medication and treatment carts attended or left standing in corridors? Do staff wash their hands before and after providing any personal care or services for residents?
Neither Medicare nor medical insurance pays for a person’s stay in a long-term care facility so it is crucial to consider financial concerns in advance. Costs can range from $40,000 to well over $100,000 a year, depending on the geographic location, the spectrum of services the facility offers, and the person’s needs. Because many families soon exhaust their resources, financial planning is essential. Each person’s circumstances are unique; the long-term care facility’s admissions coordinator typically can provide suggestions and recommendations for the most effective management of financial matters, including evaluation of resources, long-term care insurance, and applicable Medicare and Medicaid requirements.
For economic reasons long-term care facilities strive to keep their occupancy high. When it appears that the need for a long-term care setting is imminent, discuss a possible timeline with the facility’s admissions coordinator. Although facilities do not reserve space, they can plan to match availability with prospective residents.